Colorectal cancer remains one of the top three causes of cancer in OECD countries, and yet it is one of the most preventable. The number of colorectal cancer cases has risen due to population ageing, with case rates up by 21% in men and 15% in women since 2000, placing sustained pressure on healthcare systems.
Concerningly, colorectal diagnoses have surged almost 25% among young people. Although the absolute number of colorectal cancer cases remains lower than in older groups, incidence among people aged 15‑49 increased in 30 of 34 OECD countries for women and 28 of 34 for men between 2000 and 2022, pointing to a shift in risk among younger generations and calling for a close look at risk factors, screening strategies, and survivorship programmes.
Despite growing case numbers, age‑standardised mortality rates are declining, reflecting greater reach of population-based screening programmes and more effective treatment. Nonetheless, fewer than half (48%) of eligible people were screened in 2023, and participation varies eight‑fold across OECD countries. Screening rates among the lower educated are 9 percentage points (p.p.) lower than among those with higher education – with gaps exceeding 20 p.p. in some countries – while screening rates are 6 p.p. lower among men than women.
Diagnostic and treatment delays are driving worse outcomes and higher costs. Between 13% to 38% of colon cancers are detected via the emergency department, while only half of colorectal cancers (52%) are treated within 30 days of diagnosis. Thirty-day mortality after colorectal cancer surgery ranges from 1.4% to 4.1% across OECD countries – with rates up to five‑fold higher for emergency surgeries – underscoring the importance of timely detection, organised care pathways and high-quality surgical processes.
Five key approaches can reduce the colorectal cancer burden in OECD countries: 1) Increasing screening participation through easier access to testing and general practitioner (GP) engagement; 2) Ensuring timely follow-up on positive faecal tests; 3) Targeting high-risk individuals to address rising cancer rates among younger people; 4) Enacting minimum volume requirements to support better outcomes; and 5) Monitoring quality of colorectal cancer care to ensure continuous improvement.
Driving down the colorectal cancer burden
Colorectal cancer rates increased 21% among men and 15% among women since 2000
Colorectal cancer is the third leading cause of cancer for men and the second for women in OECD countries (see Figure 1). Over the past two decades, crude colorectal cancer rates have climbed sharply: spiking 21% for men and 15% for women, which means that the total number of cases is rising. However, on an age‑standardised basis, colorectal cancer rates have fallen 7% for men and 6% for women during this period. This means that the underlying risk of being diagnosed with cancer has lowered, and that much of the rise in case numbers is due to population ageing, with more older adults reaching the age where developing colorectal cancer is more common.
Crude cancer rates per 100 000 population, all ages, OECD33 average
Note: 2022 or latest available data. All cancer sites except for non-melanoma skin cancer are included. See OECD/European Commission (2026[1]) for additional notes on methodology and country definitions.
Source: Adapted from OECD/European Commission (2026[1]), Delivering High Value Cancer Care: European Cancer Inequalities Registry Analytical Report, https://doi.org/10.1787/060869fe-en.
Colorectal diagnoses have surged almost 25% among young people
Concerns are mounting that colorectal cancer is increasingly affecting people at younger ages, well before traditional screening begins. A study of Australia, Canada, England and the United States found that people born in the 1990s face a five‑fold higher risk of colorectal cancer before age 50 compared to those born in the 1960s (Downham et al., 2025[2]), while in Europe, a 20‑country assessment showed substantial increases in colorectal cancer incidence among adults under age 49 (OECD/European Commission, 2026[1]). The drivers of this surge remain unclear, but some evidence points to early-life bacterial exposure as a potential risk factor, while a study among female nurses suggests that the consumption of ultra-processed food is also associated with increased risk.
The OECD’s findings mirror these global concerns. Colorectal cancer incidence among women aged 15‑49 years rose in 30 of 34 OECD countries between 2000 and 2022, climbing 25% on average (Figure 2). Some countries – Australia, Korea, New Zealand, Türkiye, the United Kingdom and the United States – saw increases of 3.5 cases per 100 000 women or more. Among young men, colorectal cancer incidence grew in 28 of 34 OECD countries, rising by 23%. The steepest increases were seen in Finland, New Zealand, Norway, Sweden and the United States. Although rates remain far below those seen in older adults, the consistent, cross‑country rise in colorectal cancer among young people of both sexes signals a genuine and growing shift in disease risk.
Age‑standardised colorectal cancer incidence per 100 000, ages 15‑49
Note: Age‑standardisation is based on the 2013 European Standard Population. See OECD/European Commission (2026[1]) for additional notes on methodology and country definitions.
Source: Adapted from OECD/European Commission (2026[1]), Delivering High Value Cancer Care: European Cancer Inequalities Registry Analytical Report, https://doi.org/10.1787/060869fe-en.
The good news is that – similar to overall cancer mortality – deaths rates from colorectal cancer are falling. In the 38 OECD Member countries, colorectal cancer mortality fell on average by 16% for women and 18% for men in the decade between 2012 and 2022. The main notable exceptions were the Latin American countries of Chile, Colombia, Costa Rica and Mexico – where rates increased by 7‑16% for women and 10‑31% for men. Falling mortality rates also align with notable increases in 5‑year colorectal cancer survival seen in European countries in recent decades (OECD/European Commission, 2025[3]), with improved outcomes stemming from earlier detection and better treatment. A population‑level study found that countries that introduced colorectal faecal screening tests earlier – most notably Austria, Czechia and Germany, saw larger declines in colorectal cancer deaths (OECD/European Commission, 2026[1]). In other OECD countries, including Australia, Japan, South Korea and the United States, there too is evidence of a strong link between higher screening rates and lower colorectal cancer mortality (Cancer Council, 2024[4]; Lee et al., 2024[5]; Tanaka et al., 2023[6]; Zauber, 2015[7]). Treatment today also benefits from an expanded range of targeted therapies for advanced colorectal cancer, guided by tumour-specific biomarkers that enable more precise treatment selection and improved clinical outcomes. Furthermore, overall survival improves when colorectal cancer care is delivered by multidisciplinary teams, highlighting the benefits of initiatives to improve care co‑ordination.
Colorectal cancer screening rates vary eight‑fold across OECD countries, with rates higher among women
Colorectal cancer screening programmes help detect cancer at an earlier stage among asymptomatic individuals, when treatment is more effective and cheaper, and outcomes are better. Based on the national screening guidelines in each country, about half (48%) of the eligible population was screened for colorectal cancer in OECD countries in 2023 (Figure 3). Screening uptake ranged between 9% in Hungary to 74% in Finland, with rates above two‑thirds of the population also seen in England (United Kingdom), the United States and the Netherlands. Except for Korea, in all countries with gender data available, women had higher screening participation rates compared to men, for an average gap of 6 p.p. in the OECD. The largest gender gaps – of over 10 p.p. – were reported in Estonia, Norway and Slovenia.
Note: Participation rates come from programme data, except for Canada, Japan and the United Sates, which are from survey data. Data for Ireland, Finland, France and Luxembourg are provisional values. For Norway, the definition differs. Data for the United Kingdom refer to England. Data is from 2023, except for Australia, Switzerland, Canada and Japan which refer to 2020-2022.
Source: OECD Health Statistics.
People with lower education are less likely to participate in colorectal cancer screening
People with lower socio-economic status tend to participate less in cancer screening programmes due to lower awareness of cancer risk and the importance of screening, alongside greater access barriers and challenges in navigating the health system. On average in OECD countries, individuals with low education had a 9 p.p. lower participation in colorectal cancer screening than those with high education (OECD/European Commission, 2026[1]). The largest education-related gaps, of 20 p.p. or more, were observed in Denmark, Israel and Lithuania.
Colorectal cancer is still being caught too late
Colorectal cancer is ideally detected through screening programmes or when patients recognise early symptoms and consult with their primary care doctor, who identifies the potential cancer and refers them for the appropriate diagnostic tests. However, in some cases, patients only seek help once the disease has become severe, leading to their arrival in the emergency room with serious complications.
The share of colon cancers first identified during an emergency department visit varies widely across countries, ranging from 13% in Luxembourg to 38% in Belgium (Figure 4), with a similar range for rectal cancer. The impact of screening programmes – which generally target the population between ages 50‑74 years old – is visible in the lower rates of emergency department presentation among those aged 50‑69. In contrast, patients 15‑49 years old are more likely to be diagnosed later, presenting to the emergency department with aggressive cancers or unrecognised symptoms. As compared to before the COVID‑19 pandemic, the share of emergency colon cancer diagnoses increased in recent years in Belgium and Denmark, while decreasing in Latvia (OECD, 2025[8]).
Note: Most recent 3‑year average. Data refer to proportion of people aged 15+ years diagnosed with cancer who visited an emergency department with a principal diagnosis related to the cancer within 30 days of their confirmed diagnosis. For Canada, overall rate only includes Alberta and British Columbia; age breakdowns only include data from Alberta. See OECD (2025[8]) for additional notes on methodology and country definitions.
Source: Adapted from OECD (2025[8]), “Assessing cancer care quality in OECD countries: New indicators for benchmarking performance”, https://doi.org/10.1787/b3f47ece-en.
Almost half of colorectal cancer cases remain untreated within 30 days of diagnosis
Within the OECD, about half (52%) of colorectal cancer cases were treated within 30 days of tissue diagnosis (Figure 5). The highest rates were in Denmark, Belgium, Norway and Ireland, while treatment timeliness was the lowest in Colombia. Women were slightly more likely to begin treatment within 30 days than men across countries, with the largest gender gaps seen in Ireland (65% of women vs. 56% of men) and Estonia (45% vs. 39%).
Note: Most recent 3‑year average. For Canada, first treatment is based solely on surgical and radiation treatments and data are based on two provinces, Alberta and Prince Edward Island. See OECD (2025[8]) for additional notes on methodology and country definitions.
Source: OECD (2025[8]), “Assessing cancer care quality in OECD countries: New indicators for benchmarking performance”, https://doi.org/10.1787/b3f47ece-en.
Treatment timeliness for colorectal cancer appears to have been influenced by the COVID‑19 pandemic. Between 2018 and 2023, Estonia and the Netherlands saw drops of more than 10 p.p. in the share of colorectal cancer patients treated within 30 days of diagnosis. In Belgium, Canada, Denmark, Norway and Portugal, smaller declines of 1‑4 p.p. were seen.
The most common treatment for all stages of colorectal cancer is surgery. Among OECD countries, age‑standardised 30‑day mortality after colorectal cancer surgery stood at 2.5%, with rates ranging from about 1.4% in Norway to about 4% in Latvia and Czechia (Figure 6).
Gender differences in 30‑day mortality after colorectal cancer surgery are evident in most countries, with slightly lower rates for women compared to men (2.2% among women versus 2.8% for men). This result is consistent with previous studies showing higher post-surgical mortality in men, driven by their higher rate of comorbidities such as cardiovascular disease, chronic obstructive pulmonary disease, and diabetes, higher prevalence of lifestyle risk factors like smoking and heavy alcohol use, and presentation at more advanced disease stages (OECD, 2025[8]).
30‑day mortality rate after colorectal cancer surgery, age‑standardised, latest 3‑year average
Note: Standardised based on the disease population. Updated estimates based on data submissions to the OECD pilot collection between May and September 2025, with the exception of Czechia for which data were updated in April 2026. See OECD (2025[8]) for additional notes on methodology and country definitions.
Source: Adapted from OECD (2025[8]), “Assessing cancer care quality in OECD countries: New indicators for benchmarking performance”, https://doi.org/10.1787/b3f47ece-en.
Across all countries, patients undergoing emergency colon surgery are more likely to die within 30 days than those who had planned surgery. In Latvia and the Netherlands, the gaps are particularly large – with 30‑day mortality standing at about 11% for emergency cases compared to about 2% for planned surgery. However, in the Netherlands (along with Denmark and Belgium) rates of emergency surgery as a share of total colon cancer surgeries are fairly low – standing at about 10% of cases or less – while about a quarter or more of all colon cancer surgeries in Canada, Iceland, Israel, Latvia and Switzerland are done on an emergency basis. These findings underscore the critical role of diagnosing colorectal cancer through organised early detection routes – which allow for careful planning and patient preparation prior to surgery – rather than via emergency department presentation.
Increasing screening participation through easier access to testing and GP engagement
Screening uptake increases when it is easy and convenient to participate. One effective way to boost participation in colorectal cancer screening is to distribute faecal self‑sampling kits by mail or through local pick‑up points such as at community pharmacies – an approach reported by 23 of 31 OECD countries responding to the 2025 OECD Survey on High Value Cancer Care. Countries such as Australia, Finland, the Netherlands, Norway and the United Kingdom mail faecal screening kits directly to individuals’ homes – a strategy that has been shown to increase uptake, including among lower‑income groups in Ireland and the United States (OECD/European Commission, 2025[3]; OECD/European Commission, 2026[1]).
In addition to improving convenience, about half of OECD countries reported expanding the role of primary care in cancer screening. In Estonia and Latvia, primary care practices receive funding incentives based on the share of their patient list who completed colorectal cancer screening or received counselling about screening. Israel’s incorporation of colorectal cancer screening into the national quality indicators programme was associated with higher screening rates and reduced socio‑economic disparities in screening (OECD/European Commission, 2026[1]). Other countries have established dedicated roles to support screening programmes. Ireland, for example, has introduced Access Officers for each cancer screening programme to facilitate access to and provide information on screening tests.
Ensuring timely follow-up on positive faecal tests
A positive test on a colorectal cancer faecal test is only the first step towards diagnosis and must be followed by a diagnostic colonoscopy to confirm cancer. Evidence from Italy shows that non-compliance with colonoscopy after a positive faecal test is associated with a two-fold increase in colorectal cancer mortality compared with completion of the diagnostic evaluation (Zorzi et al., 2021[9])). Nonetheless, a sizable share of people with positive faecal tests do not receive appropriate follow-up. Indeed, follow-up colonoscopy rates after a positive faecal test stood at 80% in the Italian study, but rates were substantially lower in the United States (56%) and the Slovak Republic (below 50%) (OECD/European Commission, 2025[10]; Mohl et al., 2023[11]).
Many countries have not yet put in place effective programmes to monitor or ensure completion of the cancer diagnostic pathway; only 9 of 16 surveyed OECD countries report monitoring the rates of follow-up after positive screening results. Germany offers a good example here, evaluating its colorectal cancer screening programme via measures such as follow-up colonoscopy after positive faecal tests, waiting times from positive test to colonoscopy, and rates of false positives (Gesundheitsforen Leipzig GmbH, 2024[12]). In terms of effective interventions to ensure patient follow-up after positive faecal tests, the use of patient navigators and reminder systems for general practitioners to prompt timely colonoscopy have been shown to substantially increase compliance (Selby et al., 2020[13]).
Targeting high-risk individuals to address rising cancer rates among young people
Alongside population-wide screening programmes, better use of targeted screening can support efficient allocation of healthcare resources by increasing the likelihood of cancer detection among those at highest risk. Estimates from Germany find that about 20% of colon cancers relate to hereditary or familial risk, such as Lynch syndrome (Deutsches Konsortium Familiärer Darmkrebs, 2022[14]). In the United States, patients with Lynch syndrome are generally recommended to undergo colonoscopy screening every 1‑2 years starting at age 20‑25 years or 2‑5 years before the earliest age of diagnosis for an affected family member (American Cancer Society, 2024[15]). Targeted cancer screening based on family history or genetics is already reported in 21 OECD countries. Specific screening protocols for people at high risk of colon cancer have been implemented in the Slovak Republic, while Germany manages a network of clinics for patients with familial colorectal cancer. In Canada, there are delineated guidelines on who is considered at high-risk of colorectal cancer, with provinces and territories recommending screening accordingly (Canadian Partnership Against Cancer, 2024[16]). General practitioners need to be actively engaged in identifying patients at high risk of cancer by taking thorough family histories, recognising early warning signs, and informing and referring patients for genetic testing when appropriate.
Enacting minimum volume requirements to support better outcomes
With studies finding better outcomes – such as lower mortality rates – for colorectal cancer cases treated in both high-volume hospitals and among high-volume surgeons (Engdahl et al., 2023[17]), countries are implementing minimum volume requirements to ensure that providers undertaking cancer procedures have the expertise needed to deliver high quality care. A total of 13 out of 25 OECD countries report using minimum volume requirements in colorectal cancer (Czechia, Canada, Denmark, France, Germany, Hungary, Japan, Korea, Luxembourg, the Netherlands, Norway, Poland, Spain). In England as well, minimum volumes standards are set at 10 rectal cancer surgeries per facility and 5 surgeries per surgeon. Italy has recommended minimum volumes norms of 50 colon and 25 rectal cancer surgeries annually, while several small countries (e.g. Iceland and Estonia) instead opt for concentrating care in one or a few main cancer hospitals. Similarly, Ireland does not have minimum volume norms but has concentrated rectal cancer care in a set number of higher-volume centres (Burke et al., 2013[18]).
Monitoring quality of colorectal cancer care to ensure continuous improvement
A total of 25 OECD countries report mechanisms for certification or accreditation of cancer care by an outside body in order to ensure high quality. Canada’s national accreditation mechanism works in partnership with provinces to asses quality, safety, governance, and clinical standards of cancer care, while the Canadian Partnership Against Cancer has funded quality improvement initiatives focused on implementing rectal cancer standards, specifically to reduce wait times from positive CRC screening test to follow up colonoscopy (Canadian Partnership Against Cancer, 2019[19]). Spain assesses and designates centres of excellence in coloproctology based on established indicators such as surgical site infection and 30‑day mortality rates post-surgery (de la Portilla et al., 2018[20]).
In addition, quality monitoring is key to assess performance and identify areas for improvement, as done via the Dutch ColoRectal Audit in the Netherlands (See Box 1). The United Kingdom also conducts a colorectal quality audit, examining indicators such as emergency admissions or unplanned reoperations within 30 days of colorectal cancer surgery (OECD, 2025[8]). Germany publishes quality reports by cancer centre, measuring adherence to clinical guidelines – such as the share of metastatic colorectal cancer patients tested for genetic mutations before beginning their first therapy and the share of Stage IV colon cancer patients discussed in an interdisciplinary tumour conference (German Guideline Program in Oncology, 2019[21]).
TheDutch ColoRectal Audit (DCRA) is a mandatory nationwide audit collecting detailed clinical data on every primary colon and rectal cancer surgery performed in Dutch hospitals (Van Leersum et al., 2013[22]). In addition, the DCRA follows rectal cancer patients managed through “watchful waiting” rather than surgery. The audit, including data from more than 143 000 patients, tracks key outcomes such as anastomotic leakage, post-surgical complications, and mortality, with results adjusted for patient and tumour characteristics to enable fair comparison across hospitals (National Institute for Public Health and the Environment, 2025[23]; DICA, 2025[24]). It also incorporates patient‑reported outcome measures to ensure that the quality of care is assessed not only clinically but also from the patient’s perspective. Since the registry’s launch in 2009, outcomes have improved substantially: mortality declined from 6% to 2% for colon cancer surgery and from 4% to 1% for rectal cancer surgery by 2022. The DCRA is managed by the Dutch Institute for Clinical Auditing (DICA), whose quality registrations aim to improve outcomes for patients by measuring quality of care, giving benchmarked feedback to clinicians, stimulating short-cycled improvement initiatives, and promoting transparency (Beck et al., 2020[25]).
References
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[9] Zorzi, M. et al. (2021), “Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer”, Gut, Vol. 71/3, pp. 561-567, https://doi.org/10.1136/gutjnl-2020-322192.
Contact
Liora Bowers (✉ liora.bowers@oecd.org)
Alexia Sanchez (✉ alexia.sanchez@oecd.org)
Caroline Berchet (✉ caroline.berchet@oecd.org)